The effect of carvedilol on morbidity and mortality in patients with chronic heart failure

Authors: Packer M, Bristow M, Cohn J, Colucci W, Fowler M, et al.
Source: New England Journal of Medicine. 334:1349-55. May 23, 1996.
Institutions: Multi-institutional in the US.
Financial support: SmithKline Beecham, Boehringer-Mannheim.



Multiple lines of evidence point to activation of the adrenergic nervous system as a concomitent and aggravating factor in congestive heart failure. Adrenergic blockade is thus a plausible approach to therapy, but the reliance of the failing heart on sympathetic tone to maintain function leads to a risk of dramatic decompensation if adrenergic support is abruptly withdrawn. Thus, trials of beta-blockade in heart failure have been carried out very slowly and with caution. Initial results have been positive but have shown mainly symptomatic benefit rather than reduced morbidity and mortality. This randomized, placebo-controlled trial, multi-institutional in the US, was designed specifically to look at morbidity and mortality. The agent investigated was carvedilol, a non-selective beta-blocker with alpha-1 blocking (vasodilating) and anti-oxidant properties.



(since the carvedilol group was larger than the placebo group, percentages are more meaningful here)



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October 24, 1996

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